To the Editor:
We read the recent article by Roberts et al with great interest.1 Alternate models of care are indeed essential in closing gaps to access rheumatology care, by streamlining and optimizing high-quality arthritis care delivery. We notice that the 2 physiotherapists integral to this study1 are described in the discussion as having 10 years of clinical experience (apprentice-based learning) in 1 case, and formal but unspecified academic training in the other. This limits the reader’s understanding of their exact competencies, and thus the reader’s ability to extrapolate the skill sets required to perform this advanced role.
We are unequivocally supportive of leveraging the expertise of allied health practitioners (AHPs) to support burgeoning arthritis care needs. We contend, however, that there is value and strength, not only from the perspective of care delivery but also for the purposes of patient safety, government advocacy, and funding of these important roles, in standardizing and declaring the competencies required of those who serve in an extended role.
It is with this in mind that we were surprised to find that the authors failed to acknowledge the extensive literature of the evaluation and success of allied healthcare triage as performed by Advanced Clinician Practitioner in Arthritis Care (ACPAC)-trained extended role practitioners (ERPs),2-6 a program developed and delivered in Canada. These studies show a high level of triage concordance between rheumatologists and these ERPs, using highly trained and skilled AHPs.
The ACPAC program (https://acpacprogram.ca/) has been in existence in Canada for 20 years and has trained over 130 experienced practitioners for extended roles in arthritis care. This year-long, university-based certificate course provides standardized competency-based education, including a foundation of knowledge and skills essential to the development of a high degree of clinical judgment and acumen required for triage and co-management of patients with arthritis. It is considered an investment in the widening circle of care due to existing but diminishing traditional human health resources required to deliver arthritis care in Canada.
AHPs, in our opinion, require standardized post entry to practice education, as well as experience, to optimize these advanced specialty roles. Formal postlicensure training assures achievement of important competencies that benefit both the providers with whom care is shared as well as the recipients, the patients. We strongly advocate for this training to be formally recognized by not only AHP organizations but also by government agencies, so that these individuals can use the full scope of their specialized, advanced practice roles to build capacity for high-quality care delivery.
Footnotes
FUNDING
The authors declare no funding or support for this work.
COMPETING INTERESTS
Current directors of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) program, from which a stipend is received for the role: AS, LP, LS, DML, CN. ACPAC ex-officio founding directors: RS, KL.
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